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Psych PAs and reimbursement issues, esp Medicaid & Commercials.


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I would enjoy hearing from practicing psych PAs about any road bumps they have encountered with being paid as a PA vs Psych Advanced Nurse Practioner. I've recently looked for another position and find that 80-90 % of psych jobs want the psych ANP because "it's easier to bill for their services in mental health". Also, in Illinois, last year I was restricted from seeing Medicaid patients. I was told PAs are not eligable to bill in mental health...this was from the investigative arm of Illinois Medicaid, whereas the billing/payment arm had no problem with PA reimbursements. (this info was from my SP) Fortunately I have found another psych position in another state. I did call AAPA about this, and they seem to be 'somewhat' aware of this problem, but have no direct information about cause nor correction. There are a fair number of psych jobs listed with the various recruiters that read " psych PA/NP", but upon closer examination the employer only accepts psych NPs. hope someone out there has some information. to me, it feels like PAs are effectively being shut out of mental health care.

Guest TerryF

I am interested in learning more about this.

 

TerryF

Guest TerryF

I don't think there is much interest in this forum in psychiatry.

 

TerryF

I don't think there is much interest in this forum in psychiatry.

 

TerryF

 

This forum is but a reflection of the society as a whole.

So when you consider that... there isn't much interest in society in psychiatry.

Part of our "rugged individualism" and ideas/ideals concerning FREEDOM dictates that one can be as "crazy" as a a loon and as long as it isn't affecting the neighbors...

 

Mental illness is only addressed and its care funded when the sufferer causes a problem for the community in which they live.

Guest TerryF

If you google psychiarty, psychiatric, psychiatrist I think you may find more interest than you realize.

Oh, and do a search in news; the topic appears constantly.

 

I believe psychiatry is much more than you realize, and the subject dives much deeper.

 

TerryF

If you google psychiarty, psychiatric, psychiatrist I think you may find more interest than you realize.

Oh, and do a search in news; the topic appears constantly.

 

I believe psychiatry is much more than you realize, and the subject dives much deeper.

 

TerryF

 

I don't need to "google" anything... and you are entitled to "believe" as you may...

 

As for what I "realize" ... well probably not much even though I have been working in "Behavioral-PsychoSomatic Medicine" (aKa-PSYCHIATRY/Addiction/Internal Medicine) for quite a few yrs now (since late 2007).

 

Neither the fact that I have a Masters concentrated in Psychiatry, nor the fact that I am currently employed as the lead PA in 2 large PNW mental health organizations (Inpatient and Outpatient) and happen to be responding to you in this thread from the inpatient unit of one of them in-between seeing involuntarily detained psych patients adds any credence to the possibility that I may possess some knowledge of the depth of the subject of Psychiatry.

 

Yeah... ok, that's cool.

 

I'll simply defer to your psychiatry knowledge and experience and slowly back out of this fledgling discussion...

 

Carry on... :heheh:

Guest TerryF

Thank you for sharing your credentials. I will not bore you with my training and experience. "There isn't much interest in society in psychiatry", cannot be backed with statistics and numbers, IMHO. More and more people are realizing they have problems that can be treated and are seeking professional help, instead of listening to those who claim they are crazy or are just making things up. There is now more psychiatric hope than ever before.

 

I would venture to say there is more interest today than ever before in psychiatry. Psychiatric reality is now an accepted fact, in almost all quarters in this country. I'm not talking about who pays for all of this. That does not concern me in this conversation.

 

Thank you for sharing your thoughts. I am carrying on, sir, thank you.

 

TerryF

I've recently looked for another position and find that 80-90 % of psych jobs want the psych ANP because "it's easier to bill for their services in mental health".

 

This has been true in my experience also IF the ARNP is a psych NP. If the ARNP is say... a... FNP, then they will have the same billing issues as PAs working in Psych.

 

Also, in Illinois, last year I was restricted from seeing Medicaid patients. I was told PAs are not eligable to bill in mental health...this was from the investigative arm of Illinois Medicaid, whereas the billing/payment arm had no problem with PA reimbursements. (this info was from my SP)

 

Have never heard this (I no longer work or live in IL)... and it sounds like the folks in springfield is confused... or your SP doesn't know what they are talking about. As far as I know... if a physician can legally supervise you in a medical specialty, the third party payers pay for it as either "incident to" or at the lower PA rate.

 

Here... at one point, they tried to say that PAs couldn't testify as the "psych expert" in court hearings... and even showed me where it only listed Physicians and ARNPS in the state law as expert witnesses in detainment/involuntary hold hearings.

 

It pissed me off... so I did my own research and a few days later showed them the state law that says PA-Cs can "Testify to and attest to," sign and certify ANYTHING that their SPs can in the normal performance of their clinical duties. It was never brought up again and isn't a problem because now i am usually dodging them to avoid testifying in court.

 

Fortunately I have found another psych position in another state. I did call AAPA about this, and they seem to be 'somewhat' aware of this problem, but have no direct information about cause nor correction. There are a fair number of psych jobs listed with the various recruiters that read " psych PA/NP", but upon closer examination the employer -only accepts psych NPs. hope someone out there has some information. to me, it feels like PAs are effectively being shut out of mental health care.

 

Typical AAPA sitting like "deer in the headlights"...

Those psych jobs usually have a few PsychNPs and psychiatrist already employed and are often looking for Internal Medicine PA-Cs to round out the treatment team by competantly managing the patient's acute and chronic "medical issues"... because those PsychNPs could recite a insulin sliding scale if their lives depended on it and the last time the psychiatrist did it was in 1986, back in med school before residency.

 

This is how I got started in psych. I then persued psychiatry specific education to legitemize my psych practice and subsequent billing and now work as both a psych prescriber and medicine consultant. At both of tyhe practices I work at... they simply bill psych and/or medicine under my NPI. Its never been a problem since:

a.) I have a piece of paper that says my grad degree is in "psychiatry"

b.) Theoretically... there is no difference in a PA working in psych under the supervison of a licensed physician and a PA working in Surgery, Cardiology, Endocrinology, Neurology, Rheumetology, Radiology under the supervision of a licensed physician. Especially when you consider that the majority of allopathic and osteopathic physicians and ARNPs in psychiatry DO NOT do psychotherapy and only diagnosis and med/Rx/symptom/side effect management.

 

"There isn't much interest in society in psychiatry", cannot be backed with statistics and numbers, IMHO....

 

Umm... yes it can retrospectively and or by extrapolation.

All you have to do is examine the nationwide dismal and continuing declining expenditures/funds earmarked for mental health... or examine why insurance companies nationwide are not REQUIRED to cover mental health costs... or why very little time is spent on "behavioral health" issues in primary care training when ~75% of all mental health issues are managed by PCPs... or why are we still closing mental health facilities and agencies at alarming rates in EVERY STATE... or why are there fewer psychiatry residencies offered.

 

I'm positing that as a society... collectively, we usually fund things, programs and services we genuinely care about and/or is simply interested in...

That said... we haven't funded mental health very well for several decades

  • 11 months later...

I'm bringing this thread back to life because a few months ago, my hospital informed us that PAs/NPs can no longer bill for initial evals done on patients with Medical Assistance (here, the psych services are managed by Value Behavioral Health of Pennsylvania) on the inpatient unit. Their new guidelines state that the H&P must be done by a physician only, and they have stopped reimbursing for H&Ps conducted by anyone other than a physician (we do not have any NPs here, but I am one of two PAs).

 

A huge percentage of our patients (the majority, I would say) have this insurance, and this has resulted in a) Poor continuity of care, as the MDs are doing most initial evals, with PAs taking over for subsequent care, b) Decreased productivity, and therefore, revenue, by the PAs, as we now do far fewer H&Ps because of lack of payment, and c) Frustration and burnout of the physicians, due to the huge increase in forced workload for them, in order to continue getting the hospital paid for these patients' stays.

 

We have tried contacting various people at AAPA and PSPA for help in challenging this change, but have received no response. Administration at the hospital has also not been very supportive, and I doubt they comprehend the clinical impact this has had. Though we are very unhappy about this backwards move by the insurance companies, most of us have resigned ourselves to this fate; however, I fear that other insurances will follow suit, and I refuse to accept and allow the sentiment that PAs cannot conduct adequate H&Ps and should, therefore, not be reimbursed for doing so. Up until a few months ago, there was no problem with this, so I am baffled as to why this move was made.

 

Has anyone else experienced issues with this? If you could provide any information, contacts, advice, etc. that might help in disputing this change and preventing future similar problems, it would be much appreciated! Thank you so much for your time!

For Clarity...

 

Are you saying that the problem is with NPs/PAs performing and their employers billing for Complete History & Physical exams... as is done by NPs and PAs all over this nation...??????

 

Or is the problem with Psych evaluations... and/or Therapy... and/or Medication Management... ???

 

Also...

 

It makes no sense... that NPs and PAs can perform reimbursable H&P anywhere in the USA except on that unit.

 

What about the NPs and PAs down in the ED, in Surgery or on the Hospitalist crew... can their H&Ps be billed...???

I'm bringing this thread back to life because a few months ago, my hospital informed us that PAs/NPs can no longer bill for initial evals done on patients with Medical Assistance (here, the psych services are managed by Value Behavioral Health of Pennsylvania) on the inpatient unit. Their new guidelines state that the H&P must be done by a physician only, and they have stopped reimbursing for H&Ps conducted by anyone other than a physician (we do not have any NPs here, but I am one of two PAs).

 

A huge percentage of our patients (the majority, I would say) have this insurance, and this has resulted in a) Poor continuity of care, as the MDs are doing most initial evals, with PAs taking over for subsequent care, b) Decreased productivity, and therefore, revenue, by the PAs, as we now do far fewer H&Ps because of lack of payment, and c) Frustration and burnout of the physicians, due to the huge increase in forced workload for them, in order to continue getting the hospital paid for these patients' stays.

 

We have tried contacting various people at AAPA and PSPA for help in challenging this change, but have received no response. Administration at the hospital has also not been very supportive, and I doubt they comprehend the clinical impact this has had. Though we are very unhappy about this backwards move by the insurance companies, most of us have resigned ourselves to this fate; however, I fear that other insurances will follow suit, and I refuse to accept and allow the sentiment that PAs cannot conduct adequate H&Ps and should, therefore, not be reimbursed for doing so. Up until a few months ago, there was no problem with this, so I am baffled as to why this move was made.

 

Has anyone else experienced issues with this? If you could provide any information, contacts, advice, etc. that might help in disputing this change and preventing future similar problems, it would be much appreciated! Thank you so much for your time!

Call Michael Powe at AAPA. He should be able to figure out whats going on. If I understand this, Medical Assistance in Pennsylvania is the same as Medicaid. This should be reimbursed.

Ok... just finished talking to our billing manager.

 

She says that they have had NO issues with billing any insurance company/third party payer for any of the services I provide.

I specifically asked about Medicaid/Medicare and she says NO PROBLEMS.

 

She also went on to say that she can't see why there would be any problems since everything that I do... for all intents and purposes... is basically considered as if the Physician SPs themselves did it. (Delegation of services as DEPENDENT providers)

 

As Dave suggested... contact someone for some assistance, because this insurance company can't simply "negate and ignore the Penn State PA practice act" and ala-cart pick and choose what PA-NP services they will or will not re-imburse without some say-so from that state's insurance commission.

 

If they won't pay for regular ole H&Ps today performed by NPs/PAs today... will they not pay for prescriptions written by NPs/PAs tomorrow...???

I'm bringing this thread back to life because a few months ago, my hospital informed us that PAs/NPs can no longer bill for initial evals done on patients with Medical Assistance (here, the psych services are managed by Value Behavioral Health of Pennsylvania) on the inpatient unit. Their new guidelines state that the H&P must be done by a physician only, and they have stopped reimbursing for H&Ps conducted by anyone other than a physician (we do not have any NPs here, but I am one of two PAs).

 

A huge percentage of our patients (the majority, I would say) have this insurance, and this has resulted in a) Poor continuity of care, as the MDs are doing most initial evals, with PAs taking over for subsequent care, b) Decreased productivity, and therefore, revenue, by the PAs, as we now do far fewer H&Ps because of lack of payment, and c) Frustration and burnout of the physicians, due to the huge increase in forced workload for them, in order to continue getting the hospital paid for these patients' stays.

 

We have tried contacting various people at AAPA and PSPA for help in challenging this change, but have received no response. Administration at the hospital has also not been very supportive, and I doubt they comprehend the clinical impact this has had. Though we are very unhappy about this backwards move by the insurance companies, most of us have resigned ourselves to this fate; however, I fear that other insurances will follow suit, and I refuse to accept and allow the sentiment that PAs cannot conduct adequate H&Ps and should, therefore, not be reimbursed for doing so. Up until a few months ago, there was no problem with this, so I am baffled as to why this move was made.

 

Has anyone else experienced issues with this? If you could provide any information, contacts, advice, etc. that might help in disputing this change and preventing future similar problems, it would be much appreciated! Thank you so much for your time!

 

This is the information given to us by Value Behavioral Health of Pennsylvania, who manages behavioral health services for Medical Assistance recipients in 13 Western Pennsylvania counties (Armstrong, Beaver, Butler, Cambria, Crawford, Fayette, Greene, Indiana, Lawrence, Mercer, Venango, Washington, and Westmoreland):

 

"On January 11, 2012, the ValueOptions National Credentialing Committee approved the addition (highlighted below) to the inpatient psychiatric credentialing criteria, based on a request from the ValueOptions National Clinical and Quality teams, to ensure consistency with ValueOptions medical necessity criteria. Please note that all the criteria below will be reviewed during VBH-PA Quality, Compliance, and/or other audits and/or reviews of inpatient psychiatric providers."

 

The one addition was this: "Must have an initial visit with an attending physician within 24 hours of admission for evaluation and treatment planning and a documented daily visit with an attending licensed prescribing provider."

 

The initial visit is the psychiatric H&P, which was always done by either a psychiatrist or PA, with no problems. Since the above does not specify that the H&P itself has to be conducted by the MD, just "an initial visit," the PAs continued to conduct the full H&Ps within 24 hours of admission, and the MDs just had a face-to-face visit with the patient within the same time period and wrote a brief note, saying they agreed with the PA's evaluation and treatment plan. However, VBH continued to deny payment for these H&Ps done by PAs, since it did not meet their criteria for "an initial visit with an attending physician!"

 

I have the e-mail address for the VBH-PA Director of Compliance, and I plan on contacting her about this, but I am not sure of what I should say exactly. I want to provide strong information that cannot be negated.

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